Name* First Name Last Name E-mail* DEDICATION Donation Amount $ Dedication FOUNDATIONAL BRICK Sponsor a foundational brick for $1800 with monthly donations of $75 for 24 months. Monthly Donation $75 x 24 months One time $1,800 Total $0.00 Payment Payment* Credit Card Paypal Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2024202520262027202820292030203120322033 Expiration YearPaypal has been selected. Payment will take place on the next page. Dedication Text 0/100 Submit Please wait a few seconds for acknowledgement online that your information was received. If you have problems with this form please notify us by clicking here. Donations via this page are tax deductible in the United States. U.S. EIN# 03-0498942 Checks can be sent to American Friends of Chabad of Thailand 80 Shore Road Port Washington, NY 11050 If you need a tax receipt in Thailand, Israel, Australia or the UK, please contact us and do not donate via this form. We will send you donation information. Thank you! Should be Empty: This page uses TLS encryption to keep your data secure.